Provider Demographics
NPI:1023881406
Name:NUESCA, AUDREY MICHIKU MAGBOJOS
Entity type:Individual
Prefix:
First Name:AUDREY MICHIKU
Middle Name:MAGBOJOS
Last Name:NUESCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2857
Mailing Address - Country:US
Mailing Address - Phone:973-327-7868
Mailing Address - Fax:
Practice Address - Street 1:349 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2857
Practice Address - Country:US
Practice Address - Phone:973-327-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02216900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty